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Lee N, Cho HH, Cho MS. Extramedullary Relapse of Acute Lymphoblastic Leukemia Involving the Parotid Gland: A Case Report and Literature Review. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:394-399. [PMID: 36237920 PMCID: PMC9514444 DOI: 10.3348/jksr.2021.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 06/02/2021] [Accepted: 06/29/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Nim Lee
- Department of Radiology, Medical Research Institute, College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Hyun-Hae Cho
- Department of Radiology, Medical Research Institute, College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Min-Sun Cho
- Department of Pathology, Medical Research Institute, College of Medicine, Ewha Womans University Seoul Hospital, Seoul, Korea
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2
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Cross A, Chajewski OS, Rutland C, Smith K, Woodham P, Skipper D, Lindsey KG. Myeloid sarcoma diagnosed on pleural effusion cytology: A case report and literature review. Diagn Cytopathol 2021; 49:E316-E319. [PMID: 33751858 DOI: 10.1002/dc.24739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/04/2021] [Accepted: 03/08/2021] [Indexed: 11/06/2022]
Abstract
Myeloid sarcoma (MS) is a mass-forming, extramedullary infiltration of myeloid blasts rarely presenting in cases of acute myeloid leukemia (AML). These tumoral masses rarely occur at any and multiple anatomic sites, precedent or coincident with bone marrow evidence of AML. We report a case of MS that presented as pancreatic and cardiac masses where subsequent evaluation of pleural effusion cytology rendered the diagnosis. Primary MS diagnosed via pleural effusion cytology is not yet reported in literature. Herein, we report the case of a 45-year-old man who presented with abdominal pain. An infiltrative mass was identified in the pancreatic head, suspicious for pancreatic adenocarcinoma. Despite multiple attempts, Fine needle aspiration cytology of the pancreatic mass failed to render a definitive diagnosis. Subsequent thoracentesis of a right pleural effusion revealed cytologically malignant cells, identified as myeloid blasts after immunohistochemical and flow cytometric evaluation. Although rare, MS should be considered as a diagnostic possibility in the evaluation of malignancy with an unknown primary.
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Affiliation(s)
- Ashley Cross
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Olga S Chajewski
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Cooper Rutland
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Keenen Smith
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Paige Woodham
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Daniel Skipper
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kathryn G Lindsey
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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3
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Kaur K, Patel T, Patra S, Trivedi P. Cytomorphology, Immunophenotype, and cytogenetic profile of leukemic serous effusions. Diagn Cytopathol 2021; 49:948-958. [PMID: 33973738 DOI: 10.1002/dc.24772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 02/09/2021] [Accepted: 05/03/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Serous effusions (SE) in leukemic patients can be due to infections, therapy, volume overload, lymphatic obstruction or malignancy having implications on treatment and mortality. The objective of the present study is to highlight the spectrum of cytomorphology, immunophenotype, and cytogenetics in leukemic serous effusions (LSE). MATERIALS Present study is retrospective and descriptive. We reviewed all the SE, which were reported as suspicious or positive of leukemic infiltration from 2016 to 2019 for cytomorphological features. CSF and effusions involved by lymphomas were excluded. Cyto-diagnosis was compared with primary proven diagnosis (by ancillary techniques) and disconcordant cases were analyzed. RESULTS Out of total 9723 effusions, only 0.4% (n = 40) showed leukemic involvement and included nine cases of AML, three of B-ALL, 13 T-ALL, 2 MPAL, 6 CML, 5CLL, one each of chronic myelomonocytic leukemia and AML with myelodysplasia. The most common site of involvement was the pleural cavity (n = 30), followed by the peritoneal cavity (n = 7) and the pericardial cavity (n = 3). T -ALL (41.9%) was the most common leukemia involving pleural fluid followed by AML (23.3%). CML (42.8%) was the most common leukemia involving the ascitic fluid followed by B-ALL (28.6%). Accurate diagnosis was given on cytomorphology in 72.5% (29/40) cases and 15.0% (6/40) were reported as non-Hodgkin lymphoma. CONCLUSION Cytology is an effective tool available to make a diagnosis of LSE. Nuclear indentations in large atypical cells and cells with eosinophilic granular cytoplasm with sparse or abundant eosinophils in the background are an important clue in favor of leukemia over lymphoma.
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Affiliation(s)
- Kanwalpreet Kaur
- Department of Oncopathology, Gujarat Cancer and Research Institute, Ahmedabad, India
| | - Trupti Patel
- Pathology, PDCC Oncopathology, Associate Professor, Department of Oncopathology, Gujarat Cancer and Research Institute, Ahmedabad, India
| | - Sanjiban Patra
- Department of Oncopathology, Gujarat Cancer and Research Institute, Ahmedabad, India
| | - Priti Trivedi
- Head of Department, Department of Oncopathology, Gujarat Cancer and Research Institute, Ahmedabad, India
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4
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Wang ST, Chen CL, Liang SH, Yeh SP, Cheng WC. Acute myeloid leukemia with leukemic pleural effusion and high levels of pleural adenosine deaminase: A case report and review of literature. Open Med (Wars) 2021; 16:387-396. [PMID: 33748423 PMCID: PMC7957840 DOI: 10.1515/med-2021-0243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 01/07/2021] [Accepted: 01/29/2021] [Indexed: 12/21/2022] Open
Abstract
Pleural effusions are rarely observed in association with acute myeloid leukemia (AML), and their true incidence remains unknown. Given the low diagnostic yield from cytopathologic analysis of malignant pleural effusions and the fact that patients with leukemia are often thrombocytopenic and unable to tolerate invasive procedures, the incidence of leukemic effusions may be underestimated. Here, we report a rare case of pleural effusion in a patient with newly diagnosed AML. Initial analysis revealed an exudative, lymphocyte-predominant effusion. High levels of adenosine deaminase (ADA) were detected in pleural fluid, consistent with a diagnosis of tuberculosis. However, the analysis of pleural cytology revealed leukemic cells, permitting the diagnosis of leukemic effusion to be made. The patient underwent induction chemotherapy and pleural effusion resolved without recurrence. This case emphasizes the diagnostic dilemma presented by high levels of ADA in a leukemic pleural effusion, as this association has not been previously considered in the literature.
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Affiliation(s)
- Sing-Ting Wang
- Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chieh-Lung Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Hsin Liang
- Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Peng Yeh
- Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Chien Cheng
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, No. 2, Yude Road, Taichung 404, Taiwan
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5
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Pi Y, Wang B, Wang L, Ren H. Polyserositis as a primary clinical manifestation of CD7+ acute myelogenous leukemia with myeloid sarcoma: A case report. Medicine (Baltimore) 2020; 99:e23615. [PMID: 33327333 PMCID: PMC7738120 DOI: 10.1097/md.0000000000023615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Myeloid sarcomas (MS) are defined as rare extramedullary masses composed of immature myeloid cells. MS mostly develops in patients with acute myeloid leukemia (AML), and involves primarily the skin, soft tissues, bones, and lymph nodes. Pleura and pericardium involvement of MS are extremely uncommon. Polyserositis is also a very rare extramedullary presentation of acute myeloid leukemia (AML). PATIENT CONCERNS A 30-year-old woman with a complaint of right neck mass combined with coughing for 2 months as well as fever and systemic edema for the last 10 days, was admitted to our center on July 11, 2019. Initial positron emission tomography (PET) scan indicated systemic lymphadenopathy, bilateral pleural effusion, and pericardial effusion. DIAGNOSIS The initial pathological diagnosis of lymph nodes was MS. Subsequent bone marrow analysis confirmed AML. INTERVENTIONS Conventional IA induction regimen followed by high-dose cytarabine (HiDAC) regimen. OUTCOMES Complete absorption of pericardial and pleural effusion after the first cycle of IA induction chemotherapy. LESSONS Polyserositis can be an extramedullary presentation of AML. Patients with polyserositis should undergo routine flow cytometric analysis. For AML with extamedullary infiltration, systemic chemotherapy should be administered in all confirmed cases.
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MESH Headings
- Adult
- Antimetabolites, Antineoplastic/administration & dosage
- Antimetabolites, Antineoplastic/therapeutic use
- Cytarabine/administration & dosage
- Cytarabine/therapeutic use
- Diagnosis, Differential
- Female
- Humans
- Leukemia, Myeloid, Acute/complications
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/drug therapy
- Pericardial Effusion/etiology
- Pleural Effusion/etiology
- Positron-Emission Tomography
- Sarcoma, Myeloid/complications
- Sarcoma, Myeloid/diagnosis
- Sarcoma, Myeloid/diagnostic imaging
- Sarcoma, Myeloid/drug therapy
- Tomography, X-Ray Computed
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Wallhult E, Kenyon M, Liptrott S, Mank A, Ní Chonghaile M, Babic A, Bijkerk J, Bompoint C, Corbacioglu S, de Weijer R, Fink C, Marktel S, Soni V, Sprenger S, Arjona ET, Mohty M. Management of veno-occlusive disease: the multidisciplinary approach to care. Eur J Haematol 2017; 98:322-329. [DOI: 10.1111/ejh.12840] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2016] [Indexed: 12/18/2022]
Affiliation(s)
- Elisabeth Wallhult
- Section of Haematology and Coagulation; Department of Internal Medicine; Sahlgrenska University Hospital; Göteborg Sweden
| | - Michelle Kenyon
- Department of Haematological Medicine; King's College Hospital NHS Foundation Trust; London UK
| | | | - Arno Mank
- Academic Medical Centre; Amsterdam The Netherlands
| | - Mairéad Ní Chonghaile
- National Stem Cell Transplant Unit (Adults); Department of Haematology; St James's Hospital; Dublin Ireland
| | - Aleksandra Babic
- Oncology Institute of Southern Switzerland (IOSI); Bellinzona Switzerland
| | - Jacobine Bijkerk
- UMC Utrecht Cancer Center, Hematologie; University Medical Center Utrecht; Utrecht The Netherlands
| | - Caroline Bompoint
- Département d'Hématologie et de Thérapie Cellulaire; CHRU Montpellier-site Saint Eloi; Montpellier France
| | - Selim Corbacioglu
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation; University of Regensburg; Regensburg Germany
| | - Roel de Weijer
- UMC Utrecht Cancer Center, Hematologie; University Medical Center Utrecht; Utrecht The Netherlands
| | - Claudia Fink
- Klinik für Hämat, Onkol, Klin.Immun.; Heinrich Heine Universität; Düsseldorf Germany
| | - Sarah Marktel
- Hematology and BMT Unit; San Raffaele Hospital; Milan Italy
| | - Vivek Soni
- Royal Marsden NHS Foundation Trust; Sutton UK
| | - Sarah Sprenger
- Department of Stem cell Transplantation; University Hospital Eppendorf; Hamburg Germany
| | | | - Mohamad Mohty
- Hematology Department; Hôpital Saint-Antoine, and Université Pierre & Marie Curie; Paris France
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7
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Kim JY, Im SA, Lee JH, Lee JW, Chung NG, Cho B. Extramedullary Relapse of Acute Myeloid and Lymphoid Leukemia in Children: A Retrospective Analysis. IRANIAN JOURNAL OF PEDIATRICS 2016; 26:e1711. [PMID: 27617062 PMCID: PMC4992152 DOI: 10.5812/ijp.1711] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 01/27/2016] [Accepted: 02/07/2016] [Indexed: 12/15/2022]
Abstract
Background Extramedullary relapse (EMR) is a recurrence of leukemia in sites other than the bone marrow, and it exhibits a relatively rare presentation of relapse of acute leukemia. However, EMR is an important cause of treatment failure among patients with acute leukemia. Therefore, early detection of these relapses may improve the prognosis. Objectives To describe the disease-related demographic and clinical features and radiologic findings for children diagnosed with EMR in acute leukemia. Patients and Methods The study was based on 22 children (M: F = 14: 8; mean age 7.30 (2.1 - 15.7) years) with 8 acute myeloid leukemia (AML) and 14 acute lymphoid leukemia (ALL) who had experienced an EMR. Age, gender, clinical symptoms, initial extramedullary disease (EMD), French-American-British (FAB) morphology, cytogenetics, time to and site of EMR, concurrent bone marrow relapse (BMR), radiologic findings, and outcomes were evaluated. Results No definite relationship was found between initial EMD and EMR. A predilection for AML to relapse in the central nervous system (CNS), except for the CSF and bone, and for ALL to relapse in the CSF and kidney seemed to occur. Patients with EMR had a significantly higher incidence of t(8: 21) cytogenetics and FAB M2 and L1 morphologies. EMR accompanied with concurrent BMR occurred in 31.8% of the patients, who exhibited a relatively grave clinical course. Radiologic findings were nonspecific and had a great variety of structure involved, including bulging enhancing mass in the CT scan, hypoechoic mass in the US, and enhanced mass-like lesion in the MRI. Conclusions Knowledge of the potential sites of EMR, their risk factors, and their clinical and radiologic features may be helpful in the early diagnosis of relapse and planning for therapy.
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Affiliation(s)
- Jee Young Kim
- Department of Radiology, Seoul St. Mary's hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soo Ah Im
- Department of Radiology, Seoul St. Mary's hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Corresponding author: Soo Ah Im, Department of Radiology, Seoul St. Mary's hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. Tel: +82-222581455, Fax: +82-25996771, E-mail:
| | - Ju Hyun Lee
- Department of Radiology, Seoul St. Mary's hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Wook Lee
- Department of Pediatrics, Seoul St. Mary's hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Nak Gyun Chung
- Department of Pediatrics, Seoul St. Mary's hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Bin Cho
- Department of Pediatrics, Seoul St. Mary's hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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8
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Sahu KK, Tyagi R, Law AD, Khadwal A, Prakash G, Rajwanshi A, Varma SC, Malhotra P. Myeloid Sarcoma: An Unusual Case of Mediastinal Mass and Malignant Pleural Effusion with Review of Literature. Indian J Hematol Blood Transfus 2015; 31:466-71. [PMID: 26306072 DOI: 10.1007/s12288-015-0536-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 03/24/2015] [Indexed: 10/23/2022] Open
Abstract
Myeloid sarcoma is an extramedullary tumor seen most commonly in patients with acute myeloid leukemia and less frequently in chronic myeloid leukemia, myelodysplastic syndrome and rarely, in an isolated form without any other underlying malignancy. Malignant pleural effusion in hematological malignancies is rare when compared with solid tumors. We present an unusual case of myeloid sarcoma in which a mediastinal mass with pleural effusion was the initial presentation. A 27 year old gentleman presented with complaints of fever, chest pain and swelling in the anterior chest wall for 6 months. Examination revealed a lump measuring 5 × 5 cm on the left side of the chest wall. Hematological evaluation showed hemoglobin-14.2 g/dL, platelet count-233 × 10(9)/L, TLC-117 × 10(6)/L with normal differential counts. Contrast enhanced computerised tomography (CECT) confirmed the presence of a soft tissue mass in the superior mediastinum abutting against the chest wall. Core biopsy was suggestive of myeloid sarcoma and immunohistochemistry was positive for myeloperoxidase and negative for CD3, CD 20 and CD 23. Pleural fluid analysis showed the presence of malignant cells. Bone marrow examination did not show an excess of blasts. A final diagnosis of extramedullary myeloid sarcoma with malignant pleural effusion was made. The patient was given induction chemotherapy (3 + 7 regimen) with daunorubicin and cytosine arabinoside. Repeat CECT done on day 28 showed complete resolution of pleural effusion and significant reduction in the size of mediastinal mass. The patient has successfully completed three cycles of consolidation therapy following which there has been complete resolution of the mass. He remains asymptomatic on close follow up.
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Affiliation(s)
- Kamal Kant Sahu
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Ruchita Tyagi
- Department of Cytology and Gynecologic pathology, Postgraduate institute of Medical Education and Research, Chandigarh, 160012 India
| | - Arjun Datt Law
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Alka Khadwal
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Gaurav Prakash
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Arvind Rajwanshi
- Department of Cytology and Gynecologic pathology, Postgraduate institute of Medical Education and Research, Chandigarh, 160012 India
| | - Subhash Chander Varma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Pankaj Malhotra
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
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9
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Singhal RL, Monaco SE, Pantanowitz L. Cytopathology of myeloid sarcoma: a study of 16 cases. J Am Soc Cytopathol 2015; 4:98-103. [PMID: 31051716 DOI: 10.1016/j.jasc.2014.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 09/26/2014] [Accepted: 10/01/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The diagnosis of myeloid sarcoma (MS) in cytology samples is challenging, especially when these tumors occur prior to a diagnosis of acute myeloid leukemia. The aim of this study was to review our cytopathology service's experience with a series of MS cases. MATERIALS AND METHODS Archival records were searched from which 16 cytology cases of MS were identified and reviewed. Clinical findings, cytomorphology, and ancillary studies were analyzed. RESULTS MS was secondary to acute myeloid leukemia in 14 cases, chronic myeloid leukemia (CML) in blast crisis in 1 case, and myelodysplastic syndrome in another. Flow cytometry was supportive in 11 cases, immunostains were helpful when performed in 4 cases, and fluorescence in-situ hybridization in the CML case showed t(9;22). Cellularity was variable in all leukemia subtypes. Blasts had round or cleaved nuclei with indistinct nucleoli. Maturing granulocytes were present only in the patient with CML, or with peripheral blood contamination (4 cases). Other blood precursors were absent. Apoptosis and lymphoglandular bodies were present in almost one-half of the cases, which correlated with increased blasts. Mitoses were infrequent (6 cases) and necrosis was not seen. CONCLUSIONS The diagnosis of MS in cytology specimens can be made in cases with adequate cellularity and supportive ancillary studies in the correct clinical context. MS was harder to diagnose in cytology cases with low cellularity, blood contamination, and few blasts. Cytologic features that pose diagnostic pitfalls are lymphoglandular bodies suggestive of lymphoma and maturing or mixed granulocytes that mimic infection.
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Affiliation(s)
- Rashi L Singhal
- Department of Pathology, University of Pittsburgh Medical Center, 5150 Centre Avenue, Pittsburgh, Pennsylvania
| | - Sara E Monaco
- Department of Pathology, University of Pittsburgh Medical Center, 5150 Centre Avenue, Pittsburgh, Pennsylvania
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, 5150 Centre Avenue, Pittsburgh, Pennsylvania.
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10
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Pemmaraju N, Chang E, Daver N, Patel K, Jorgensen J, Sabloff B, Verstovsek S, Borthakur G. Extramedullary acute myeloid leukemia: leukemic pleural effusion, case report and review of the literature. Front Oncol 2014; 4:130. [PMID: 24918086 PMCID: PMC4040935 DOI: 10.3389/fonc.2014.00130] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 05/16/2014] [Indexed: 12/17/2022] Open
Abstract
Objective and Importance: Malignant pleural effusions occur in the setting of both solid and hematologic malignancies. Pleural effusion caused by leukemic infiltration is an unusual extramedullary manifestation of acute myeloid leukemia (AML) with fewer than 20 cases reported (1–11). We report a case of pericardial and pleural effusions in a patient with AML and review the literature. Clinical Presentation: In this case, a 55-year-old man with previous history of myeloproliferative neoplasm experienced transformation AML, heralded by appearance of leukemic pleural effusions. The patient was identified to have leukemic pleural effusion based on the extended cytogenetic analysis of the pleural fluid, as morphologic analysis alone was insufficient. Intervention: The patient was treated with hypomethylator-based and intensive chemotherapy strategies, both of which maintained resolution of the effusions in the remission setting. Conclusion: Due to the rarity of diagnosis of leukemic pleural effusions, both cytogenetic and fluorescence in situ hybridization testing are recommended. Furthermore, systemic chemotherapy directed at the AML can lead to complete resolution of leukemic pleural effusions.
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Affiliation(s)
- Naveen Pemmaraju
- Department of Leukemia, The University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Elaine Chang
- Department of Leukemia, The University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Naval Daver
- Department of Leukemia, The University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Keyur Patel
- Department of Pathology, The University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Jeffrey Jorgensen
- Department of Pathology, The University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Bradley Sabloff
- Department of Radiology, The University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Srdan Verstovsek
- Department of Leukemia, The University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Gautam Borthakur
- Department of Leukemia, The University of Texas MD Anderson Cancer Center , Houston, TX , USA
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11
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Duhan A, Kalra R, Kamra HT, Agarwal A, Rana P, Agarwal R, Verma S. Leukaemic pleural effusion as a manifestation of acute myeloid leukaemia: a case report and review of literature. Ecancermedicalscience 2014; 8:397. [PMID: 24567754 PMCID: PMC3919480 DOI: 10.3332/ecancer.2014.397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Indexed: 11/30/2022] Open
Abstract
Haematologic malignancies such as acute and chronic leukaemias rarely present with or develop pleural effusion during their clinical course. We present a case of a young female who presented with unilateral pleural effusion and was diagnosed with haematologic malignancy on pleural fluid cytology. On further workup, a diagnosis of acute myeloid leukaemia was established. The patient was put on chemotherapy thereafter. This case clearly highlights the importance of cytopathology aids in making a diagnosis of rare and unusual presentation in haematologic malignancies.
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Affiliation(s)
- Amrita Duhan
- BPS Government Medical College for Women, Khanpur, Sonepat, Haryana 131305, India
| | - Rajnish Kalra
- BPS Government Medical College for Women, Khanpur, Sonepat, Haryana 131305, India
| | - Hemlata T Kamra
- BPS Government Medical College for Women, Khanpur, Sonepat, Haryana 131305, India
| | - Anand Agarwal
- BPS Government Medical College for Women, Khanpur, Sonepat, Haryana 131305, India
| | - Parveen Rana
- BPS Government Medical College for Women, Khanpur, Sonepat, Haryana 131305, India
| | - Ruchi Agarwal
- BPS Government Medical College for Women, Khanpur, Sonepat, Haryana 131305, India
| | - Sanjay Verma
- BPS Government Medical College for Women, Khanpur, Sonepat, Haryana 131305, India
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12
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Matsui T, Hidaka M, Kiyokawa T, Murayama T, Kawano F. Successful Treatment of Bulky Granulocytic Sarcoma of the Retroperitoneum with High-Dose Chemotherapy and Autologous Peripheral Blood Stem Cell Transplantation. J Clin Exp Hematop 2013; 53:235-9. [DOI: 10.3960/jslrt.53.235] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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13
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Chang H. Acute myeloid leukemia with leukemic pleural effusion. Diagn Cytopathol 2012; 41:909-13. [PMID: 22550016 DOI: 10.1002/dc.22859] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 03/01/2012] [Indexed: 11/07/2022]
Abstract
Acute myeloid leukemia (AML) may be associated with extramedullary tumor growth, which is commonly known as myeloid sarcoma. Although AML with leukemic pleural effusion is considered rare, the true incidence is not clear. We report three cases of AML involving pleural effusion in this study. The cases were encountered in a single institute within two years, suggesting that leukemic effusion is more common than previously reported. Leukemic cells showed evidence of monocytic differentiation in all cases. Two patients presented with advanced AML. Both had concurrent myeloid sarcoma. Both were ineligible for intensive treatment and died soon after diagnosis of myeloid sarcoma. The third patient had pleural effusion upon diagnosis of AML. Remission was achieved and the effusion disappeared after treatment. We conclude leukemic effusion may become more common in an era of improved care and prolonged survival for AML patients. The prognostic impact is unclear and patients should be given standard AML treatment whenever possible.
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Affiliation(s)
- Hung Chang
- School of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Hematology-Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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14
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Jeong SH, Han JH, Jeong SY, Kang SY, Lee HW, Choi JH, Park JS. A case of donor-derived granulocytic sarcoma after allogeneic hematopoietic stem cell transplantation. THE KOREAN JOURNAL OF HEMATOLOGY 2010; 45:70-2. [PMID: 21120167 PMCID: PMC2982999 DOI: 10.5045/kjh.2010.45.1.70] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 03/09/2010] [Accepted: 03/09/2010] [Indexed: 01/22/2023]
Abstract
The occurrence of granulocytic sarcoma as a pattern of relapse after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is rare. In this paper, we report a rare case of acute myeloid leukemia (AML) relapsed as a granulocytic sarcoma of the donor type. The patient was diagnosed as having AML and underwent an allo-HSCT from his matched sibling donor. Fifty-seven months after allo-HSCT, he developed granulocytic sarcomas of duodenum, jejunum, and left sterno-cleido-mastoid muscle. The bone marrow was normal with 100% donor chimerism. A Y chromosome PCR was performed on the patient's duodenum specimen as well as bone marrow aspirate in order to check the patient-origin cells. The duodenal specimen was found to contain 41.2% SRY-positive cells (from the donor). Repeat endoscopy on day 2 of chemotherapy showed that the granulocytic sarcoma had shrunk dramatically. The patient died of sepsis during the nadir state 35 days after starting salvage chemotherapy.
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Affiliation(s)
- Seong Hyun Jeong
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea
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F-18 FDG PET/CT findings in a case of gastric relapse of acute myeloblastic leukemia. Clin Nucl Med 2009; 34:788-90. [PMID: 19851176 DOI: 10.1097/rlu.0b013e3181b81d80] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Ocheni S, Iwanski GB, Schafhausen P, Zander AR, Ayuk F, Klyuchnikov E, Zabelina T, Fiedler W, Schnittger S, Hochhaus A, Brümmendorf TH, Kröger N, Bacher U. Characterisation of extramedullary relapse in patients with chronic myeloid leukemia in advanced disease after allogeneic stem cell transplantation. Leuk Lymphoma 2009; 50:551-8. [PMID: 19373652 DOI: 10.1080/10428190902755513] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Recently, higher extramedullary relapse rates following allogeneic stem cell transplantation (SCT) in myeloid malignancies were reported e.g. because of selection of poor-risk patients. We analysed five consecutive patients with post-transplant extramedullary relapse of chronic myeloid leukemia (CML) out of a total of 24 patients (21%) undergoing allo-SCT. All five patients with extramedullary relapse had clonal evolution and a history of blast phase (BP). In particular, 56% of the patients in BP had extramedullary relapse with no extramedullary relapse in patients with chronic/accelerated phase. Most frequent manifestation sites were the skeletal system, the muscles/subcutaneous tissue and the central nervous system. In one case chloroma was mimicking myositis of the lower limbs. Combined approaches were performed including irradiation (n = 4), chemotherapy (n = 2), IM (n = 2), dasatinib (n = 4), nilotinib (n = 1), a novel aurora-kinase-inhibitor (n = 1), donor lymphocytes (n = 2) or a second allo-SCT (n = 2). Transient response was achieved in one case, stable partial remissions in two cases, whereas two cases were refractory. Research should focus on prospective studies aiming to improve treatment of extramedullary relapse in stem cell recipients with CML with a special focus on the role of second generation tyrosine kinase inhibitors.
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Affiliation(s)
- Sunday Ocheni
- Clinic for Stem Cell Transplantation, University Cancer Centre Hamburg, Hamburg, Germany
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Mediastinal mass and malignant pleural effusion in an aleukemic case with pre-B acute lymphoblastic leukemia. J Pediatr Hematol Oncol 2009; 31:139-41. [PMID: 19194202 DOI: 10.1097/mph.0b013e31818c2619] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pleural effusions and mediastinal masses are associated with certain types of hematologic malignancies. We report a 20-year-old man with a pleural effusion, a mediastinal mass, and a normal hemogram. The cytology of the pleural effusion initially suggested a lymphoma. However, an immunophenotypic study of the effusion revealed the following: TdT+, CD34+, CD19+, CD7(-), CD33(-), CD10(-), sIgM(-), and positive cytoplasmic mu heavy-chain immunoglobulins. After a bone marrow examination, we diagnosed the patient with pre-B acute lymphoblastic leukemia (ALL). This is the first reported case of a malignant pleural effusion and a mediastinal mass that preceded pre-B ALL. After standard therapy for ALL, the patient has been disease-free for 7 years.
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18
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Imataki O, Ohnishi H, Kitanaka A, Kubota Y, Tanaka T, Ishida T. Isolated extramedullary relapse presenting as autologous lymphocyte response. Am J Hematol 2008; 83:512-4. [PMID: 18306363 DOI: 10.1002/ajh.21165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Isolated EMR in the CNS is a relatively rare form of recurrent leukemia. We report here a case of a 38-year-old man with inv(16) acute myeloid leukemia (AML, M2) who suffered a central nervous system (CNS) relapse after allogeneic bone marrow transplantation (BMT) from a human leukocyte antigen (HLA)-matched sibling donor. After complete remission was achieved by chemotherapy, he received allogeneic BMT from his HLA-matched sister. His leukemia relapsed in the CNS 2.5 years after the allogeneic BMT. Lumbar puncture revealed 780/muL white blood cells with 67.3% leukemia cells and 32.7% mature lymphocytes. Fluorescent in situ hybridization (FISH) using a probe for the Y chromosome demonstrated that both leukemia cells and lymphocytes in the cerebrospinal fluid (CSF) were derived from the recipient, although the bone marrow cells were from the donor. No leukemia cells with inv(16) were detected by FISH in the bone marrow. This is the first report to clarify the chimerism of lymphocytes in the CSF of patients with isolated EMR in the CNS after allogeneic SCT, in which analysis revealed that autologous immunologic cells rather than donor lymphocytes responded to the recurrent isolated leukemic cells in CNS. This observation suggests that the CNS is a "sanctuary" site not only from chemotherapy but also from the graft-versus-leukemia effect. The present case contributes to our understanding of the possibility of immunological escape phenomenon of recurrent leukemia cells in extramedullary sites.
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Affiliation(s)
- Osamu Imataki
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan.
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Fatih T, Selim Y, Mesut A, Demirel YN, Yuksel P. An unusual cause of unilateral pleural effusion in the setting of aortic stenosis: acute myeloid leukemia. Intern Med 2007; 46:325-7. [PMID: 17380003 DOI: 10.2169/internalmedicine.46.6004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Pleural effusion has various causes. In the setting of aortic stenosis, new onset pleural effusion is generally considered as a consequence of heart failure. Here, we describe a 50-year-old male patient who had been followed with aortic stenosis for 30 years. During his admission he presented with exertional dyspnea and pleuritic chest pain. He had no other symptoms or findings of cardiac failure. Complete blood count revealed neutrophilic leukocytosis, a normal hemoglobin level and normal platelet count. Left sided pleural effusion was noted on the posteroanterior chest X-ray. Examination of the pleural fluid revealed myeloid blasts. Bone marrow aspiration smear and flow cytometric analysis of the bone marrow and pleural fluid were consistent with acute myeloid leukemia.
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Affiliation(s)
- Tufan Fatih
- Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Turkey.
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20
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Abstract
Recurrent or residual leukemia found in extramedullary sites after intensive treatments adversely affects prognosis. To summarize the sites and outcomes when extramedullary relapses have been reported after stem cell transplants, and to elucidate when long survival has been achieved, 207 cases were analysed. Authors were contacted for follow-up information. The most commonly reported sites are soft tissue in acute leukemias and bone in CML. Extramedullary relapse occurred typically within 2 years in ALL, but later in one-third of myeloid leukemias. Most testicular relapses reported in AML followed non-TBI conditioning. Marrow relapse was not inevitable if aggressive treatment was begun early. Local therapy alone was generally inadequate. Intensive therapy has produced lengthy remissions in cases of acute leukemias involving various sites, whereas CML cases, particularly involving bone, were most resistant to treatment. Heightened awareness and aggressive treatment should improve the prospect for cure after extramedullary relapse.
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MESH Headings
- Adolescent
- Adult
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bone Neoplasms/pathology
- Bone Neoplasms/therapy
- Female
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Leukemia, Myeloid, Acute/pathology
- Leukemia, Myeloid, Acute/therapy
- Male
- Middle Aged
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/therapy
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/pathology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy
- Soft Tissue Neoplasms/pathology
- Soft Tissue Neoplasms/therapy
- Stem Cell Transplantation
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21
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Potenza L, Luppi M, Riva G, Morselli M, Ferrari A, Imovilli A, Giacobbi F, Temperani P, Donelli A, Narni F, Torelli G. Isolated extramedullary relapse after autologous bone marrow transplantation for acute myeloid leukemia: case report and review of the literature. Am J Hematol 2006; 81:45-50. [PMID: 16369953 DOI: 10.1002/ajh.20421] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Isolated extramedullary relapse (IEMR) is a pattern of acute myeloid leukemia (AML) relapse post-allogeneic bone marrow transplantation (alloBMT). Less is known about IEMR post-autologous BMT (autoBMT) and about factors associated with IEMR. We report a case of a woman with M4 AML who experienced IEMR post-autoBMT and review the related literature. Seventy-two alloBMT and 3 autoBMT patients, including ours, were identified. The review suggests that an M2 or M4 French-American-British (FAB) phenotype, intermediate cytogenetic risk group, and chromosome 8 abnormalities are more frequently associated with the occurrence of IEMR. IEMR occurs earlier in autoBMT than in alloBMT. Combined treatment with radiation and high-dose chemotherapy may be effective. When we searched the European Bone Marrow Transplant Registry (EBMTR) database, we found the incidence of IEMR to be statistically greater in alloBMT than in autoBMT (11% vs. 6%; P = 0.02), but no correlations have been found with the conditioning transplant regimen used. A closer follow-up, including body and central nervous system scan, should be considered in patients who are undergoing BMT presenting with several IEMR-associated factors.
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MESH Headings
- Aged
- Antimetabolites, Antineoplastic/administration & dosage
- Bone Marrow Transplantation
- Central Nervous System/diagnostic imaging
- Chromosome Aberrations
- Chromosomes, Human, Pair 8
- Combined Modality Therapy
- Cytarabine/administration & dosage
- Fatal Outcome
- Female
- Humans
- Leukemia, Myeloid, Acute/complications
- Leukemia, Myeloid, Acute/diagnostic imaging
- Leukemia, Myeloid, Acute/therapy
- Radiography
- Recurrence
- Registries
- Transplantation, Autologous
- Transplantation, Homologous
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Affiliation(s)
- Leonardo Potenza
- Section of Hematology and Bone Marrow Transplant, Department of Oncology and Hematology, University of Modena and Reggio Emilia, Modena, Italy
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